Digging Wellness in the NICU
Jae Kim, MD, PhD / November 2019
My recent move to Cincinnati has awoken my love of trees. Living near a forest made me more acutely aware of my senses. The smell of trees and majestic presence of tall oaks brought calm to my inner balance. I started reading articles on the therapeutic benefits of walking and being present in the forest, a process cutely called “forest bathing.” Some physicians have actually researched this effect and shown tremendous health benefits to this practice, including positive effects on blood pressure, autonomic system, and mood.1 This has activated my own journey in improving my wellness.
My wife and I celebrated our 29th anniversary in October by traveling through southern Chile and hiking through parts of breathtaking Patagonia. While heading south on our trip, a bird severely damaged one of the plane engines and grounded us overnight, leaving us to wait for another available plane. The irony of suffering a long delay with multiple travel lineups in order to experience our trip of wellness was not lost on us. The subsequent views, however, including a powerful crashing waterfall and a picturesque lakeside volcano, justified the wait.
Nurturing our own wellness
Wellness is mentioned a lot now in medicine. Alongside this is burnout amongst healthcare professionals, a condition that is real and palpable on a scale that is measured every week.
When was the last time you had a colleague leave work due to stress, change positions due to the workload, or have an outburst from the challenges of work?
Institutions are starting to recognize and address this problem more, as this can hurt operational objectives. I think creating or preserving wellness in the hospital setting can be quite elusive, as the financial pressures hospitals face lead to added stressors for neonatal staff and providers.
Most practices tend to run very lean, optimizing RVU to FTE ratios, but those ratios don’t account for individual variation and effects of fluctuating workforce numbers. Repeated demanding fluctuations in workload ultimately take its toll, and can have long-lasting effects that make it hard to recover any previous state of wellness. Burnout may have a measurable effect on the quality of healthcare delivery too, as shown recently by Tawfik et al.2 Hopefully more studies like this will persuade the maintenance of an equilibrium of wellness in our health systems.
Balancing career and wellness
I recently learned that more than 80% of our hospital staff are Gen Y (Millennials) and Gen X. Younger generations seem to have more appreciation of work-life balance and/or are more empowered to speak up if there are imbalances. Finding work-life balance is the rage now.
Unfortunately, frontline healthcare professionals do not seem to have much latitude for accommodating this concept. Furthermore, as many of our neonatal providers are women, many of them accept the challenging trials of giving birth with relatively rapid return to work with expectations of full performance coming back.
The NICU is a community
I think we are in need of finding wellness for the whole community of the NICU. That includes parents.
Most of our patient’s parents find themselves with an unexpected raw deal. Their dreams of a natural and uncomplicated birth are fractured by an institutionalized reality that can last for months. Finding wellness for them starts by feeling safe with the trajectory of the story of their infants. Despite the harshness of the truth, parents are most appreciative of honesty and clarity on what to expect from their child’s condition. Helping them learn coping mechanisms to deal with the stress of having a NICU baby is an essential part of a long-term, healthy transition home.
Bringing parents into the fold of their child’s care in a structured, integrated manner, such as with various family-centered care models is an important foundation. The use of peer support for parents has proven to be one of the most compelling and effective methods of patent engagement too.3
We must not forget too, that the NICU core of wellness involves the wellness of our newborn patients, who are the ones who are most unwell and most in need. It is why we are working there in the first place.
Our modern medicine attempts much too easily to sterilize the intensive care of the sick neonate. I had a wonderful experience with a mother this year in which she was experiencing the birth of a very young preterm infant.
I was struck by how she immediately interacted with her baby in her first moments, despite her infant’s size and state on a ventilator. Her hands were on her child as soon as she came up to the incubator. She was physically and emotionally connecting with her child. At some point, I asked her what she did for a living, and she told me she was a veterinarian. It struck me then, that the practice of veterinary medicine could teach us to be more forthright with our physical connection with our infants, and to model more of this to our parents, who are far too often afraid to make those critical connections.
It is natural for humans to comfort each other with touch. There is now certified training in hospitals, including the NICU, where staff can practice Healing Touch, a positive therapy that involves connecting with patients largely without actually touching them, providing support with movements of hands close to their bodies. If we can find value in this practice, surely we can seek and enrich the value of actual touch.
NICU wellness: The big picture
Holistic is a word that sometimes loses its value with medicine, as it can sometimes be associated with less rigorous, scientifically-tested forms of healing. And yet, what we are trying to achieve each day is perhaps closer to a version of holistic community healthcare. NICU is a team sport more than most specialties in medicine. We come together, with common purpose to make babies better. The time we spend with each other at work easily competes with the time we spend with our loved ones at home. Our babies need well caregivers and parents. We therefore need to find an operative that promotes our own wellbeing first even before attending to others.
Ideally, a day at work ought to feel like a fulfilling exertion of our trade, where the end of the day feeling is one of completion and accomplishment. Feeling that we made a difference helps preserve our core conviction and purpose in what we do. We need to recognize that burnout is real, damaging, and life-altering.
At the same time, wellness can be hard to protect in our place of work and life. Digging deep takes time and patience, but when the digging is done and the stream of refreshing water flows from underneath, it is all worthwhile. I’ll close here with some suggestions to ponder as we all try to dig some wellness:
- Pace yourself, as it is a long race
- Avoid negativity, as this mostly pulls you down
- Focus on what is working or on what you can control
- Surround yourself with positive people who genuinely care about you as much as you care about them
- Take care of each other at work
- Pause and breathe whenever possible
- Pay it forward
- Participate in random acts of kindness
- Get a pet
- Prioritize your family
- Go for a walk in the forest
- Travel to other places to gain perspective
Tell us about your wellness practices! What do you do to maintain balance and wellbeing?
- Hansen MM, Jones R, Tocchini K. Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. Int J Environ Res Public Health. 2017 Jul 28;14(8). pii: E851. doi: 10.3390/ijerph14080851. Review. PubMed PMID: 28788101; PubMed Central PMCID: PMC5580555.
- Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC, Sexton JB, Ioannidis JPA. Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med. 2019 Oct 8. doi: 10.7326/M19-1152. [Epub ahead of print] PubMed PMID: 31590181.
- Treyvaud K, Spittle A, Anderson PJ, O’Brien K. A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant. Early Hum Dev. 2019 Aug 27:104838. doi: 10.1016/j.earlhumdev.2019.104838. [Epub ahead of print] PubMed PMID: 31471000.
About the Author
Jae Kim is an academic neonatologist, pediatric gastroenterologist, and nutritionist at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. He has been practicing medicine for almost 30 years both in Canada and the USA. He has published numerous journal articles, book chapters, and speaks nationally on a variety of neonatal topics. He is the Division Director of Neonatology in the Perinatal Institute at Cincinnati Children’s and the longstanding Director of a nationally recognized multidisciplinary program to advance premature infant nutrition called SPIN (Supporting Premature Infant Nutrition). He is a member of the American Academy of Pediatrics Committee on Nutrition and the co-author of the book, Best Medicine: Human Milk in the NICU. Dr. Kim is a clinical consultant with Medela LLC.